UNDERWATER MEDICINE 2008 FORT YOUNG HOTEL DOMINICA January 12-19, 2008
HOTEL AND DIVING PACKAGES: All rooms are ocean front with a private balcony. Rooms have two double beds or a single king-sized bed, cable TV, hair dryer, wireless Internet access, and air conditioning. Each package includes: Room for seven nights, daily breakfast, five lunches, three dinners, taxes and gratuities, airport transfers, porters, maids, a welcome and farewell cocktail party and a t-shirt. The diving option includes: five days of two one tank dives per day, marine park fee, diving gratuities, tanks, weights and weight belts. Please circle your selection from the following options (prices listed are per person):
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Ocean Front Diver, Double Occupancy
Non-Diver, Double Occupancy |
$ 1650
$ 1215 |
Ocean Front Diver, Single Occupancy
Non-Diver, Single Occupancy |
$ 2285
$ 1850 |
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Name_________________________ Name of person sharing room _____________________ or-assign a Roomate
ROOM DEPOSIT: $600.00 per person by check or credit card. Make checks payable to: Underwater Medicine Associates Return to:
Underwater Medicine Associates| PHONE: 610-896-8806 | FAX 610-896-2883 | EMAIL: sandy@scubamed.com | |
For credit card payment* please provide the following information:
| Credit Card | VISA | MASTERCARD | AMEX | (circle one) |
Name as it appears on the card ____________________________________________________________________
Card Number __________________________________________ Expiration date __________________________
Address to which credit card statement is mailed ______________________________________________________
____________________________________________________________________________________________
Signature ____________________________________________________________________________________
* Credit Card will be billed for balance on November 12, 2007
CANCELLATION POLICY: All cancellations are subject to a $100.00 administrative fee. Due to hotel commitments, The $600.00 deposit will not be refunded for cancellations after November 12, 2007. CANCELLATIONS AFTER DEC.12, 2007 ARE NON REFUNDABLE. (INSURANCE IS STRONGLY RECOMMENDED). Please note: Rates for single occupancy are higher and every effort will be made to find a roomate for single registrants. If a roomate cannot be found, the single rate will apply. Because of advance reservations, full payment must be made by Nov 12, 2007. When your reservation is received by Underwater Medicine, Inc., You will be contacted concerning your travel arrangements.
A group discount is available on American Airlines. Please call American Airlines ( 800-433-1790), or go to www.aa.com. Authorization number for the discount is: A8418AD.
| Return to: | Underwater Medicine Associates |
| P.O.BOX 481 | |
| Bryn Mawr, PA 19010 |
| PHONE: 610-896-8806 | FAX 610-896-2883 | EMAIL: sandy@scubamed.com | |
NAME_________________________________________________Degree__________
Practice Specialty _________________________________________
Name of Companion or Spouse _____________________________
Address___________________________________City __________________________
State ___________ Zip_______________Country________________
Telephone Home_________________ Office________________ Fax____________________
Email :______________________________________________________________________
* Course Fee and Hotel Deposit can be combined in one check.
| T-shirt size: | Medium | Large | Extra Large | Extra Extra Large |
For credit card payment circle one:VISA MASTER CARD AMEX include the following information:
Name as it appears on the card ____________________________________________________________________
Card Number __________________________________ Expiration date __________________________________
Address to which credit card statement is mailed ______________________________________________________
____________________________________________________________________________________________
Signature below also confirms credit card payment.
I understand that enrollment is limited, that my money will be refunded if the course is full, and that Underwater Medicine Associates reserves the right to cancel the program and return all course monies without further obligation if sufficient attendance is not secured by October 12, 2007. I understand that to dive, I must be a certified scuba diver with a recognized certification card. I am medically sound and physically fit for diving.
SIGNATURE _______________________________________________Date _____________
SIGNATURE OF SPOUSE (if diving) _____________________________Date _____________